LANDLORD: 
MÈT KAY LA: 

 
 
 

 
 
 

NAME and ADDRESS 
NON ak ADRÈS 
 
 

 

 
VS. / KONT 
 
 
 

 
 
 

NAME and ADDRESS 
NON ak ADRÈS 
 
 

 

 

 

 

 

 

Common Pleas Docket No. 
Nimewo Lis Dosye Tribinal Defans an Komen. 

 

 

 
 
 

 

TENANT: 
LOKATÈ: 
 

 

 

 

     

     

 

 

 

COMMONWEALTH OF PENNSYLVANIA 
KOMINOTE PENNSYLVANIA 

COURT OF COMMON PLEAS 
TRIBINAL DEFANS AN KOMEN 

ounty Of 

Konte 

    C

     

 

 

 

TENANT’S SUPERSEDEAS AFFIDAVIT (NON-
SECTION 8) FILED PURSUANT TO 
Pa.R.C.P.M.D.J. No. 1013C(2) 

AFIDAVID SUPERSEDEAS LOKATÈ (KI PA 
SEKSYON 8) KI DEPOZE SELON  
Pa.R.C.P.M.D.J. NIMEWO 1013C(2) 

I, ______________________________ 
__________________________________ (print 
name and address here), have filed a praecipe for a 
writ of certiorari to review a magisterial district court 
judgment awarding to my landlord possession of 
real property that I occupy, and I do not have the 

Mwen, ___________________________ 

__________________________________ (ekri 

non ak adrès ak lèt detache la a), te depoze yon 
praecipe pou yon òdonans certiorari pou egzamine 
yon jijman tribinal distri majistral ki bay mèt kay 
mwen an posesyon byen imobilye mwen okipe a, 

financial ability to pay the lesser of three times my 
monthly rent or the judgment for rent awarded by 

epi mwen pa gen kapasite finansyè pou m peye 
montan ki pi piti nan twa fwa kòb lwaye chak mwa 

the magisterial district court. My total household 
income does not exceed the income limits set forth 

mwen an oswa jijman pou kòb tribinal distri majistral 
la akòde. Revni total moun nan kay mwen pa 

in the instructions for obtaining a stay pending 
issuance of a writ of certiorari and I have completed 
an in forma pauperis (IFP) affidavit to verify this. I 
have/have not (cross out the one that does not 
apply) paid the rent this month. 

I verify that the statements made in this 

affidavit are true and correct to the best of my 

depase limit revni ki prezante nan enstriksyon 
siplemantè yo pou m jwenn yon sispansyon 
annatandan yo bay yon òdonans certiorari epi 
mwen te ranpli yon afidavid in forma pauperis (IFP) 
pou mwen verifye sa. Mwen te/pa t (bife sa ki pa 
aplike a) peye kòb lwaye mwa sa a. 

Mwen verifye deklarasyon ki fèt nan afidavid 
sa a se verite epi yo kòrèk selon pi bon konesans, 

knowledge, information, and belief. I understand 
that false statements herein are made subject to the 

enfòmasyon ak kwayans mwen. Mwen konprann fo 
deklarasyon mwen fè nan dokiman sa a ap genyen 

penalties of 18 Pa.C.S. § 4904, relating to unsworn 
falsification to authorities. 

penalite Seksyon 18 Pa.C.S. § 4904, ki gen rapò ak 
bay otorite yo fo deklarasyon ki pa fèt sou sèman. 

______________ 

 

Date / Dat 

_____________________________________________ 
SIGNATURE OF TENANT / SIYATI LOKATÈ A 

OPC 312-08 (D) 

  _

    A